Living Wills May Proliferate

Law Requires Patients Be Told Of Right To Refuse Treatment

A new federal law requiring hospitals and nursing homes to inform patients of their right to refuse medical treatment under certain circumstances could cause a flood of requests for "living wills," say county health-care providers and attorneys.

Attorneys and doctors heresay they already have noticed increased interest in living wills, which spell out a person's wishes for medical treatment should he or she become terminally ill.

And they expect that the federal law, which will go into effect next November, will only increase the number of people asking for the legally binding document to be drawn up.

Several area health-careadministrators said they think the trend toward obtaining living wills, along with a second document called a medical durable power of attorney, can only facilitate the care of terminally ill patients or those in a permanent coma.

"The hardest thing is dealing with a person who no longer can make decisions and has never told the family what he or she wants," said Lorna J. Rice, director of social work at Carroll County General Hospital. "(The family) ends up sitting in a courtroom, letting a judge decide.

"Hospitals tend to err on the sideof doing too much," she said, adding that an increase in the number of medical malpractice lawsuits has created a climate where medical institutions may be overly cautious. "If we have specific guidelines set up in advance, it makes it a lot easier on everyone."

Rice saidhaving plans spelled out beforehand about the type of medical treatment desired also takes a lot of pressure off spouses or other close relatives, who might otherwise be forced to make the decisions.

Richard C. Murray, a partner with the Westminster law firm Walsh and Fisher, said he has noticed an increase in interest in living wills and the durable power of attorney. About 50 percent of the firm's clientswho come in to have regular wills drawn up request the additional documents as well, he said.

A living will applies in situations where patients are terminally ill, Rice said. Individuals can specify what types of medical treatment they want should they become unable to make decisions about their own medical care.

However, if people want to specify what types of treatment they want should they become permanently unconscious, such as in a coma, they need to establish a durable power of attorney for health care, he said.

This document candesignate someone to make decisions regarding health care, should the signer become disabled. Health care wishes can also be specified inthe document to guide the person given power of attorney in making decisions.

Murray attributed the increased interest in living willsand the durable power of attorney to two factors: the aging of the population and recent publicity about specific cases involving the right to die.

The Missouri case of Nancy Cruzan, who died Dec. 26 after spending eight years in a coma following a car crash, has brought national attention to the issue, he said.

But even with the increased attention surrounding this and other right-to-die cases, said Rose L. Windsor, a vice president at CCGH, a relatively small percentageof patients are entering the 118-bed facility with living wills in place.

"A lot of people know about it," she said, "but it's the kind of thing a lot of people put off doing."

She said she recently attended a seminar for health-care providers on the topic. Of 30 people attending, only one had a living will.

Even people who know all about their rights may be reluctant to get the paperwork done, she said.

She said she hopes that as more people hear about living willsthrough the media and realize the importance of making decisions in advance, they will take the time to write living wills.

"If I don't see an increase over the next couple of years, I'd be very surprised," she said.

The new federal law, which was passed last fall, will require all hospitals, nursing homes, hospices, home health-care services and health-maintenance organizations that receive Medicare or Medicaid payments to inform patients of their legal right to a livingwill and durable power of attorney for health care, said Jack Schwartz, chief counsel for opinions and advice for the attorney general's office.

Schwartz said the legal rights have been acknowledged under Maryland law for several years. What's new is that health-care providers will be required to tell all patients about their rights.

The federal law also spells out when patients must be informed. Hospitals, for example, must make sure all patients are told before they areadmitted.

Richard Wade, vice president of communications for the Maryland Hospital Association, said most of the state's 55 acute-carehospitals already inform patients about living wills and the durablepower of attorney.

Under the new law, however, most hospitals will have to devise more specific procedures for informing patients, he said.